Republic of the Philippines )

Quezon City ) S.S.

AFFIDAVIT OF CIRCUMSTANCES OF DEATH

I, JOHN CHRISTIAN G. ORILLA, of legal age, Filipino and with residence address at 6
Hillside Lane, Brgy. Blue Ridge A, Libis, Quezon City, after having sworn to in accordance with
law do hereby deposes and state, that:

1. That my father EDUARDO ATAS ORILLA died due to pneumonia, on March 27, 2021, at
around 6:00 p.m. inside our house with address at 6 Hillside Lane, Brgy. Blue Ridge A,
Libis, Quezon City.

2. That prior to my father’s demised, he had been suffering diabetes and high blood
pressure (hypertension) where, he was taking medications as maintenance for his
ailments.

3. That there was no physician that attended with my father, because earlier that day,
around 1: 00 p.m., we rushed him to three different hospitals because his heartbeat was
below the normal rate, but he was refused to be admitted by these hospitals as their
facilities were overcrowded due to a high number of Covid19 patients.

4. The last physician, from Ospital ng Mandaluyoing, that I spoke to, he said that my father
seems still okay and he might need a little rest, hence, we compelled to bring our father
home so he can rest a while, and thereafter we will look for another hospital,
unfortunately, my father already given up and he passes away at 6:00 p.m. on that very
same day.

5. That I am executing this affidavit to attest to the truth of the foregoing instrument and
for any legal purpose and intents this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 29 th day of March, 2021 in
Quezon City.

JOHN CHRISTIAN G. ORILLA

Affiant
ID No._______________

SUBSCRIBED AND SWORN TO before me this 29th day of March, 2021 in Quezon
City. Affiant exhibited to me his/her Identification documents as proof of his/her
identity as indicated above.

Doc. No._____
Page No._____
Book No._____
Series of 2021.